Work related musculoskeletal injuries
Musculoskeletal Disorders (MSD’s) are injury or disorder of muscles, nerves, tendons, joints, cartilage, or spinal discs. Not caused by slips, trips, falls, motor vehicle accidents, or other accidents. MSDs are considered work-related when the work activities and work conditions significantly contribute to their development or exacerbation but are not the sole determinant of causation (World Health Organization, 1985).
- Prolonged repetitive, forceful, or awkward hand movements.
- "Static loading" or holding a posture.
- Poor conditioning of the heart and lungs, and poor muscle endurance.
- Direct mechanical pressure on tissues.
- Cold work environment.
- Poorly fitting furniture.
- Basic inadequacies of workstation design.
- Work organisational and psychosocial issues.
Early warning signs and symptoms:
- Discomfort, fatigue or pain.
- Swelling, redness, coldness or warmth.
- “Catching” or “snapping” with movement.
- Loss of grip strength, heaviness or clumsiness of the hand.
- Burning, numbness, tingling.
- Visual strain.
- The injury accumulates slowly leading to difficulty in day-to-day activities such as shaking hands, opening doors, holding newspapers, using a comb, or even holding a teacup.
Classification of WRMSD's:
The WRMSD's are classified into two broad categories:
2) Non-specific (patient presents with pain, discomfort or functional impairment but no specific diagnosis or pathology can be ascertained).
- Computer users
- Check out clerks.
- Hair dressers.
- Health professionals: surgeons, dentists.
- Massage therapists. HCA.
- Sports persons.
- Laboratory workers.
- Manual labourers.
- Assembly line workers.
Stages of WRMSD’s (severity stage of RSI - recovery period):
- Stage one: mild - two to four weeks.
- Stage two: moderate - one to three months.
- Stage three: severe - three to six months.
- Stage four: complicated - six months
- Myofascial Pain Syndrome (MPS).
- Fibromyalgia Syndrome (FMS).
- Complex Regional Pain Syndrome (CRPS).
- Tendon-related conditions.
- Nerve-related conditions.
- Circulatory/vascular conditions.
- Joint-related conditions.
Recent advances in the management of WRMSD’s:
It can be treated completely with a skilled hands-on manual therapy approach for release of muscle and fascia, along joints, nerves and other soft tissue techniques. The effect of this technique proved by researches and the studies were published in indexed journals. This treatment has been given in four phases:
Phase one (severe discomfort): Trigger Point Therapy (TPT), (ischemic compression, PRT, INIT), Myofascial Release (MFR), relaxation and breathing techniques and stretching exercises.
Phase two (moderate discomfort): soft-tissue (TPT and MFR), nerves and joints mobilization, self-stretching exercises, progressive strengthening exercises, postural retraining, body mechanics and ergonomics training.
Phase three (mild discomfort): In this phase continue with self-stretching exercises, free exercises and start of with progressive strengthening exercises followed by relaxation techniques.
Phase four (maintenance): further strength training, aerobic conditioning and yoga therapy.
“The potential for a quick and complete recovery is enhanced, if the patient seeks competent medical interventions like manual physical therapy with ergonomic workplace analysis at an early stage.”
Sharan's protocol for RSI:
Skilled hands-on approach for release of myofascial, articular, neural and soft-tissue mobilization rehabilitation protocol management of physiotherapy been followed which has been graded into 4 phases which are interlinked to each other.
Phase one - severe discomforts in the initial stage: management - myotherapy soft tissue mobilization, neural mobilization, rib mobilization, clavicular mobilization, scapula thoracic mobilization and physiotherapeutic modalities like IFT, US followed by assisted stretches.
Phase two - moderate discomforts in the upper limb and neck region: management - it is a follow up of phase one which includes more self-stretching exercises, range of motion exercises, relaxing techniques like breathing exercises, Alexander techniques and yoga therapy.
Phase three - mild discomforts: management - in this phase continue with self-stretching exercises, free exercises and start of with progressive strengthening exercises followed by relaxation techniques.
Phase four - maintenance phase: management - this consists of postural maintenance, generalised whole body stretching and strengthening exercises in order to maintain the length and strength of muscle.
Adequate micro and macro brakes should be taken in between work: do the stretches and strengthening exercise at least thrice a week. If there is any flare up of symptoms in this phase (phase four) stop all the exercises and immediately consult a physiotherapist for further clarification.
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